Although transthoracic echocardiography remains the cornerstone of diagnostic cardiac ultrasound, satisfactory images cannot be obtained in up to 20% of patients. It may be particularly difficult to acquire high quality images in patients on mechanical ventilators, after major thoracic surgery, and in the elderly. In addition, transthoracic echocardiography is of limited value in assessing prosthetic valves, atrial masses and aortic dissection.1,2 In contrast, transesophageal echocardiography (TEE) provides a superior acoustic window and overcomes many of the limitations of the transthoracic approach. Although several studies have described the safety and utility of TEE,1-7 the role of this technique in evaluating elderly patients needs clarification. This report describes our initial experience with TEE in the awake setting in 35 consecutive patients aged ≥70 years.